Written by Tanya Lieberman, IBCLC

We’re getting close to the end of our birth-related Booby Traps series on the Best for Babes Blog, but I’d be remiss if I didn’t mention two lesser known causes of low milk production which derive from birth experiences: postpartum hemorrhage and retained placenta.

Of course, no one knowingly lays these problems as traps for you. But we think that the fact that their affect on milk production is poorly recognized constitutes a potential Booby Trap.™

How are these problems related to milk production?

Retained placenta.

You probably know that the body’s signal to start the production of mature milk is the birth of your placenta. This triggers the release of hormones which are necessary for you to start producing mature milk. But when that separation is incomplete – leaving fragments of the placenta intact in the uterus – the signal is interrupted.

In Diana West and Lisa Marasco’s excellent book, The Breastfeeding Mother’s Guide to Making More Milk, the authors describe the case of one mother who sought help because of very low milk supply. Two weeks later her baby was gulping contentedly at the breast. What had happened?

When asked if there were any significant changes that week, Marie responded, “Well, I did have this really weird thing happen last week. I had a lot of cramping and then passed these big clots…” The improvement in milk production occurred soon after this event. Marie remembered that her obstetrician had kept traction on the umbilical cord until the placenta came out. Case solved.

Postpartum hemorrhage/Sheehan’s Syndrome.

Blood loss that exceeds the normal range for vaginal birth (up to 500 cc) or cesarean birth (up to 1,000 cc) can place a mother at risk of low milk production.

When a mother experiences a significant hemorrhage during or after a birth, her blood pressure can drop so low that it fails to circulate to her pituitary gland. This can cause some or all of the cells in her pituitary to stop functioning normally. It’s the pituitary that secretes key milk making hormones, and when hormone production is affected, milk production can be, too. For this reason, some experts recommend monitoring women who have have suffered postpartum hemorrhage for milk production problems. Blood loss can also create anemia, which is another risk factor for low milk production.

Did you experience a hemorrhage or have retained placental fragments? Did it affect your milk production?

I had a retained placenta. It was removed shortly after my baby’s birth. Since it was removed, I still think that it was the doctor’s keeping my baby in a separate room and his pushing of formula on my baby that delayed my milk coming in.

I had a retained placenta that actually required a d&c a month after I delivered, it not only caused initial low supply, but because of the drugs and antibiotics from the d&c, I couldn’t resume breastfeeding for 3 days after the procedure. I had to pump and dump in my totally medicated state to keep even some of my supply. It took a couple of weeks, and formula supplementing, but eventually my supply bounced back and we are still BFing 5 months later!

I had an undiagnosed placenta accreta. I haemmorhaged so badly that it took at least six weeks for me to begin to feel that I could walk without fainting, but all the while I was trying to breastfeed. Neither my midwife nor my ob/gyn mentioned to me that the blood loss could make nursing difficult so I thought my baby was just a really slow (REALLY slow – 2 hours at a stretch!) nurser. Eventually the poor little thing would just give up and fall asleep from exhaustion. Thanks Heavens – and I still do daily – for the Lactation Consultant we saw at 6 weeks who immediately got me pumping after every feed day and night, and then syringing for my baby (who absolutely refused to take a bottle till 6 months!) She warned me that we may be too late to establish a full milk supply but said that it really was my choice as to how much I wanted to try. So we nursed, pumped and syringed around the clock for 6 weeks until my baby’s weight was looking better, and then I had to continue pumping after every daytime feed till 6 months – still often getting only 50mls or so at a time. At 6 months, everything finally settled, my milk supply was strong and I could stop expressing. It was incredibly tough at the time, but my little girl is 3 years old now (and still nursing happily 🙂 !) and I’m so, so grateful that I got the right advice and the right support in time to make a difference.

I had both, and almost bled to death both times. My daughter is now 6 months old, and I am still having trouble with breastfeeding. They had me start supplementing when I had to go back to the hospital, and now she has to have on average 12 oz of formula a day. The LC at the hospital was little to no help, and kind of pushed the formula on us. I am just glad that my daughter is still able to get some breastmilk.

I had part of the placenta break off. Before I left the labour ward there was bleeding and clots and the midwife did some repeated hard pressing on my abdomen. Luckily no other intervention was needed. It was unpleaseent and a little scary considering that I’d had a very natural and uneventful birth therwise. I don’t think it made any difference to my milk as I had no difficulty feeding my baby.

I had a rather severe hemorrhage after the birth of my youngest and the only supply issues I had were overproduction. I’m thankful for it because the hemorrhage left me so exhausted, I don’t think I could have been getting up to mix bottles all the time, manage an SNS, or pump constantly. We had a lot going for us in helping develop a good supply though, much of it that I doubt most women get, especially in that situation. My husband and midwife made a point of helping me keep our daughter snuggled up with me after birth and started her nursing within the first half hour after delivery, even as the hemorrhage was being managed. My midwife immediately got me laid down and nursing my baby again in a side lay once the bleeding was under control and I was washed off. They even put a stool in the shower so I could sit supported and hold my daughter with my partner’s help while the blood was washed off (I looked like I had been in a slasher movie). I suspect the fact that there was never any significant break in nursing or contact between my baby and myself after birth probably helped keep up starting out on the right foot. I am so incredibly thankful for my birth team.

I hemorraghed after my last 3 babies, a little more each time. This last time the worst, required 3.5 bags of Pitocin after a natural labor/delivery. Thankfully, my midwife made sure that our sweet girl went straight to the breast so as to help both situations. I never had an issue with my supply but tend to have a bit of oversupply issues to begin with. Not sure I’d have been able to get through it as easily if it’d been my 1st baby vs my 4th.

I had both of these problems. I had a 1000 cc blood loss and a placenta that didn’t detach at all, so the D&C was performed right after birth. This delayed breastfeeding a bit but we tried and everything seemed pretty normal until we went home. At that point the baby was very sleepy and not getting enough, leading her to scream all night long too. Her weight loss was concerning and my doctor, who is also a lactation consultant did recommend that this was a time where supplementation might help as the baby could get some strength back to help us to nurse properly. I was completely unable to keep her awake to feed any other way. So about a week post partum we rented a hospital grade pump and I fed and pumped around the clock. I also syringed at first and then switched to bottles. What seemed to help my supply most was putting the baby to breast as much as possible, and over time DD nursed more and more as she got the hang of it. The herbal and prescriptions meds didn’t seem to help me. After about a month of supplementing and breastfeeding I was able to completely wean off formula and exclusively breastfeed. I stopped using bottles since I was so sick of them at that point (and then DD refused them from that point!) but we are still breastfeeding at 8 months and going strong. Ladies with these problems, it is REALLY hard in the beginning but if you keep trying, there is hope.

Now that I read this I realize how lucky I have been to be able to breastfeed my twins. I had a quite severe postpartum hemorrhage (lost 1,500 cc of blood and had 3 transfusions). Despite rhis I could breastfeed without big problems, maybe due to the fact that with twins you also have extra blood in the pregnancy and the stimulation of the breasts is always double…
I know how it feels after a difficult birth and I am so sorry that some mothers have problems to breastfeed afterwords.

I had c/s delivery with 75% blood loss. Transfused 4 bags of blood during surgery. Almost died during the 3.5 hour surgery. I was VERY worried about breastmilk supply. But went to lactation consultant, got on herbs, and had success, still exclusively nursing my 20 pound 6 month old. I am very thankful. every body is different tho.

I feel like I hemoraged with my son, but didn’t need a transfusion. He was a ‘sleepy baby’ and didn’t let me know when he was hungry, so dropped about a pound, which scared me, so I pushed him to eat on his sisters schedule. He gained the weight back fast, but started to scream until his first immunizations. If I hadn’t had success with my daughter, I would have given up. Interesting to know…

I had both of these issues, a severe pph with blood loss of 2500-3000ml and an immediate emergency d&c to remove retained placenta. As with a previous poster my only issue was overproduction if any. I would also attribute this to a very breastfeeding friendly hospital and supportive friends/family. I’d be interested to know if there was a direct physiological link or whether this is more a matter of a separation of mother and baby that makes a breastfeeding relationship difficult.

i had a postpartum blood loss and retained placenta piece that required a d&c immediately after birth. i didn’t see my baby for something like 6 hours, and then no one came in to help me get her to the breast. i just did it myself. i tried to breast feed, but i had NO milk. we supplemented right when we got home and i kept trying. she would fall asleep and eventually refused to latch at all! nipple shields worked for a little while, and then i started pumping. i only ever got about 8 ounces a day, so at 7 weeks, i stopped. i just couldn’t keep up with it, working, and caring for the baby full time.

i just wish i had known that my milk production issues were a result of the birth and not my own failure. i also wish i’d known that i might have problems earlier on–i would have taken herbs quicker, pumped earlier and more often, and done more to try to stimulate.

My homebirth midwife yanked on my umbilical cord to help deliver the placenta. I bled a lot also, not quite a lot also, not to hemmorage levels, but the midwives were discussing amongst themselves that if I did not deliver my placenta soon they would have to transfer me to the hospital. After 11 weeks of bleeding and the midwife assuring me that some women just bleed longer, I got a second opinion from an OB who diagnosed me with retained placenta and gave me her next available surgery date because of the risk of infection. Pathology stated that it was necrotic, literally the placental fragment was rotting inside my uterus. My daughter lost so much weight during her first weeks that I was threatened with formula by her pediatrician. Instead of sleeping when she slept, I pumped, which is no easy feat for a single mother. When she awoke I nursed her, then fed her the expressed milk with a medicine cup like my doula had instructed. For the first three months, she gained weight slowly, and the highest weight percentile she got to was 38. After the d&c her weight shot up to the 98th percentile. We are still nursing at two and two months of age, since the surgery she has never dipped below 90th percentile for weight.

I hemorrhaged to the point of needing a hysterectomy. Nothing else stopped the bleeding…not the shots not the d&c. So, I had a unplanned c-section, unplanned hysterectomy AND then when we finally got home 5 days later(they wouldn’t release me until my blood pressure was more under control)…my right arm stopped working…9 months later and it still isn’t fully functional…my shoulder doesnt move at all. They pushed formula at the hospital…I had lots of help at the hospital trying to breast feed…but couldn’t get LO to latch at home…and she screamed and screamed. So I pumped for 6 weeks (no easy feat w/a bum arm) and finally gave up to save my sanity…only produced 3-4 oz a day (pumping every 2 hours) Lots of pain then…even taking percocet. Still lots of pain…manageable w/acupuncture and energy medicine. I have a lot of “if I only knew” moments. But my LO is healthy and happy. I wish I could have breast fed. However, she was crawling @ 5 1/2 months and was walking @ 8 months and is running and talking now. I have just decided to be happy for my little miracle baby…and leave the “if onlys” behind.

I suffered all three after the birth of my second child. Only it was not my placenta that was retained it was my membranes although it had the same effect. I bled heavily after my placenta detattched and even though i’d had a chemical free delivery up until this point i was then very quickly shot with syntocynon and massaged and made incredibly sore. I was then found to be aneamic and treated accordingly. I had issues breast feeding my son until my milk arrived on day 4 but was in low supply and he just wouldnt shift from my breast.

I hemorrhaged pretty bad with my 3rd baby, I lost estimated 1700ml. I got a blood transfusion and was still anemic. They wanted to give another but I asked my OB to just let me go to my regular room so I could be with my baby more. I didn’t have any problems BFing, but I really think it’s because I had the transfusion and was not too anemic and it was my 3rd BFing baby, so I was aware of the risk and I had him on the breast pretty much all day long to try to build my milk supply.

I just had my baby 6 days ago and had hemorrhaging. My supply is super low, I will hopefully be getting a hospital grade pump tomorrow and working with a lac consultant. I didn’t know this was something that happened until I found out that my baby was completely dehydrated at 3-4 days and not passing his bilirubin.

It has been a horrible and emotional week but baby is fine with some supplementation. Reading people’s stories has given me hope…thanks for posting. I pray I can be a success story as well, I am very determined, as breastfeeding is worth it to me.

In 2011 I had my third c-section (first two were emergency) for my fourth child. My first three babies I had over-supply of milk. With this c-section I lost a lot of blood during surgery, and had to have 2 transfusions the next day. My milk didn’t come in while at the hospital for 5 days. I came back to hospital for next two days to see the LC, only got 1 ml of milk out from 15 minutes of pumping both breasts. Baby was weighed, nursed and reweighed prior to me using the breast pump, he didn’t gain anything. I started having a fever that day and went to a different hospital, then I was transferred to another. The doc there thought I might have Sheehan’s Syndrome. Fast forward to fall 2013, an MRI confirms that I have damage to my pituitary gland due to blood loss. I’ve been on synthroid for hypothyroidism, now endo wants me on something for my adrenal issue. And I can’t have any more babies without fertility assistance, I’m in premature menopause since 34 years old.

I’m 9mpp now after having a hemorrhage and d&c. Similarly I had a full/over supply with my first three children and now a chronic low supply with my fourth. I had blood work done and my thyroid came back normal which is frustrating. I am glad that my thyroid is supposedly fine but I need some explanation or reason for this low supply. I’ve exclusively pumped for all four kids and right now at 9mpp I am considering trying to relactate but wonder if that may be too late or even pointless if there was damage to my pituitary gland.

I had both of these – severe blood loss and retained placenta. I lost approx. 2500 cc’s after delivery before the doctor finally decided to do the D&C and had to have a transfusion before I left the hospital. I had lots of help breastfeeding and making sure the baby was immediately at the breast. A week after my delivery I started losing large clots of blood again. My OB did an ultrasound and found nothing. At my baby’s 2 week appt. she had lost over 1 lb so we decided to start supplementing with formula. I immediately rented the hospital pump and started pumping after feeding as much as possible. My LC advised to put her to the breast, bottle feed, and then pump for every feeding. I also take more milk plus based on the LC’s recommendation and brewer’s yeast. Nothing seemed to work to increase my supply. I have been pumping 5-6 times a day but only get 7-8oz a day and my baby is now 5 weeks old. Yesterday I started hemorrhaging again, went to the emergency room, had a ultrasound and exam only to be sent home. The ultrasound tech and radiologist reported that my endometrium is unusually thick. I followed up with my OB today who did another ultrasound and found it wasn’t my endometrium but that I still have a piece of the placenta left and my OB scheduled a 2nd D&C for tomorrow. I really hope that’s what has been causing the low supply and that we will be able to stop supplementing soon.

It has now been 4 weeks since my 2nd DNC and I wanted to update what happened. Hopefully this helps someone else going through the same thing someday. The day after the DNC my milk supply from pumping doubled right away. It still wasn’t enough to stop supplementing so I continued researching ways to increase supply. I tried brewers yeast and more milk plus. Neither seemed to work for me. I finally found Go-lacta by sugar pod naturals and it is amazing. I felt a difference as soon as I took the first capsules. I am taking 3 x 3 per day.

I had a retained placenta during the birth of my daughter 3months ago. It finally came out without needing a d&c but hemorrhaged significantly. I was severely anemic and put on blood boosters. Milk flow was dismal and was mot even able to get an ounce a day hence supplemented with formula. About a month later I was back in hospital. I had hemorrhaged yet again and once scanned it was noted that I had part of my placenta still in me. I went in for a d&c and left baby at home. Since then my milk production has not improved and she uses me as her pacifier. She is content with formula and I have accepted the fact that I am more of her side dish than the main meal. I wish I had all this information earlier then I wouldn’t have blamed myself and tried every concoction known to man to improve milk supply. At least I have learnt for next time.